3 MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE REPORT DOCUMENTATION PAGE Report No. Date ISBN Pages 218 April, Title and sub-title: Older Vulnerable Road Users Measures to Reduce Crash and Injury Risk Author(s): Jennifer Oxley, Bruce Corben, Brian Fildes, Mary O Hare, Accident Research Centre Talib Rothengatter University of Groningen Sponsoring Organisation(s): Swedish National Road Administration (SNRA) Abstract: Older pedestrians and cyclists are vulnerable road users, comprising a substantial proportion of all road fatalities world-wide. Pedestrian fatalities constitute between 20 and 30 percent of road fatalities, while cyclist deaths range from 2 percent in Australia to 10 percent in Denmark, Belgium, Germany and Sweden to 23 percent in the Netherlands. Older pedestrians and cyclists are over-represented in these figures, accounting for up to 45 percent of pedestrian fatalities and up to 70 percent of cyclist fatalities. The nature of injuries to older pedestrian and cyclists are severe once involved in a crash because they are largely unprotected and more frail than younger pedestrians and cyclists. Even in moderate crashes, the elderly are in greater danger of being seriously injured or killed than younger pedestrians and cyclists. The first section of this review provides an outline of the problem, discussing the contributing factors to increased crash and injury risk including age-related changes in functional performance, vehicle design factors and the road infrastructure, design and operation. There are consequences of ageing on sensory, perceptual, cognitive and physical abilities that can result in problems coping with traffic. Safe walking and cycling requires the adequate functioning of all these systems and loss of efficiency in any one can reduce performance and increase risk on the road. Many older pedestrians and cyclists, therefore, experience some difficulty participating safely in complex traffic. Selecting a safe gap in which to cross in front of oncoming traffic seems to be a major problem for older pedestrians and cyclists as well as adjusting walking and cycling pace and maintaining balance on a bicycle in the event of an emergency. In addition, the frontal structures of vehicles can greatly affect injury outcome. Current bumper, bonnet and windscreen design is not conducive to pedestrian and cyclist safety. Moreover, the trend of increasing numbers of large and aggressive sports-utility vehicles, four-wheel-drives and vans (often fitted with rigid bull-bars) in the vehicle fleet adversely affects the injurious consequences to pedestrians and cyclists. Last, the growing complexity of the road environment places increasing demands on an older person s adaptability. The current road system, for the most part, seems to be unforgiving for older vulnerable road users and few facilities are designed specifically for the special needs and capabilities of older adults. The second section of this report provides a comprehensive review of the international best-practice solutions aimed to reduce the crash and injury risk to older pedestrians and cyclists including behavioural/educational programs, enforcement, vehicle design improvements and improvements to infrastructure, road design and operation of the roadtransport system. Given that the behaviour of older road users is thought to contribute, in part, to their increased risk of collision, it is suggested that education, awareness and training programs as well as encouragement and enforcement of safe walking and cycling practices are considered. In terms of improvements to vehicle design, improvements to frontal structures, prohibition of rigid bull-bars and use of in-vehicle ITS applications are recommended. Consideration of changes to the road transport system to create a safer more crashworthy environment for older pedestrians and cyclists, whilst maintaining their mobility, is also recommended. It is recommended that: i) more attention be given to reducing numbers of vehicles travelling at excessive or high speeds in areas of high pedestrian activity, ii) more attention be given to reducing pedestrian-vehicle and cyclist-vehicle interactions along roads, within curves and at intersections, iii) more attention be given to reducing the complexity of traffic environments, and iv) consideration of other road design improvements such as provision of improved facilities at public transport stops and provision of good street lighting in high risk areas. Key Words: Older road users; Pedestrians; Cyclists; Mobility; Travel; Crash Risk; Exposure; Road design; Vehicle design; Behaviour. Reproduction of this page is authorised Monash University Accident Research Centre, Building 70, Wellington Road, Clayton, Victoria, 3800, Australia. Telephone: , Fax: OLDER VULNERABLE ROAD USERS iii

11 Figures FIGURE 1: MOBILITY BY TRANSPORT MODE IN THE NETHERLANDS... 8 FIGURE 2: DISTANCES WALKED PER PERSON PER DAY BY AGE GROUP AND GENDER... 9 FIGURE 3: DISTANCES CYCLED PER PERSON PER DAY BY AGE GROUP AND GENDER FIGURE 4: FIGURE 5: PROPORTION OF FATALITIES OVER 65 YEARS OF AGE ACCORDING TO CATEGORY OF ROAD USER FOR SELECTED EUROPEAN COUNTRIES RISK OF DEATH PER BILLION KILOMETRES TRAVELLED BY AGE AND MODE OF TRANSPORT IN THE NETHERLANDS, FIGURE 6: CASUALTY RATES BY AGE PER 100 MILLION KMS TRAVELLED AND ROADS CROSSED FIGURE 7: RISK OF PEDESTRIAN DEATH AS A FUNCTION OF VEHICLE IMPACT SPEED FIGURE 8: SEVERE BICYCLIST CASUALTIES IN VICTORIA REGISTERED WITH THE TRANSPORT ACCIDENT COMMISSION: JULY 1981-JUNE FIGURES 9 AND 10: EXAMPLES OF CARRIAGEW AY NARROWING FIGURES 11 AND 12: EXAMPLES OF MEDIAN/REFUGE ISLANDS FIGURES 13 AND 14: EXAMPLES OF ROAD SURFACE TREATMENTS FIGURES 15 AND 16: EXAMPLES OF ROUNDABOUT INSTALLATION FIGURES 17 TO 20: SOME EXAMPLES OF GATEWAY TREATMENTS TABLE 1: Tables AVERAGE NUMBER OF BICYCLE KILOMETRES TRAVELLED PER RESIDENT PER YEAR IN SELECTED EUROPEAN COUNTRIES, TABLE 2: FATALITY RATES FOR PEDESTRIANS AND CYCLISTS PER 100,000 POPULATION BY AGE GROUP AND COUNTRY IN TABLE 3: SUMMARY OF SAFETY EFFECT OF MEASURES TO IMPROVE PEDESTRIAN SAFETY 87 OLDER VULNERABLE ROAD USERS xi

12 xii MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE

13 EXECUTIVE SUMMARY Crashes involving pedestrians and cyclists are serious in nature and constitute a substantial proportion of serious injuries and deaths on the road. Moreover, many involve older adults, who are more vulnerable because of age-related frailty. Older pedestrians and cyclists experience many problems using the transport system and this is reflected in the types of crashes they are involved in. Like older drivers, they are over-represented in crashes in complex traffic environments such as at intersections, in fast and heavy traffic, on multilaned roads and when performing a complex manoeuvre. While many road safety strategies and policies recognise the vulnerability of older road users, particularly pedestrians and cyclists and emphasise the need to reduce their injuries, there are very few programs that specifically accommodate the special needs of these groups. Traditionally, the road network has been designed primarily for vehicles and little thought has been directed to the provision of features that allow safe and comfortable travel by older pedestrians and cyclists. However, more recent philosophies such as Vision Zero in Sweden and Sustainable Safety in the Netherlands view safety as the prevailing consideration. These models argue that the road-transport system can only be safe when the road infrastructure is designed and operates in a ways that explicitly recognises both human tolerance to violent forces and normal human error, so that death and serious injuries to all road users can be prevented. This means that special consideration of the needs of the most vulnerable road users should be taken into account in all road safety programs, policies and strategies. The Project A literature review was undertaken to assess the current state of knowledge in regard to the key issues affecting senior vulnerable road users (namely, older pedestrians and cyclists) and to identify a set of best-practice recommendations for managing the safety of these road user groups. In particular, the review addressed: Older pedestrian and cyclist travel patterns and mobility needs, Older pedestrian and cyclist crash risk, The increased vulnerability associated with ageing, Older pedestrian and cyclist crash and injury types, and Measures to reduce the crash and injury risk to older pedestrians and cyclists (including behavioural and educational programs, improved vehicle design, and improved infrastructure and road design). The findings of the review were used to compile a set of recommendations to improve the safety of these road user groups while meeting their transport and mobility needs. The Problem Pedestrian fatalities constitute between 20 and 30 percent of all road fatalities world-wide and a substantial proportion of those involve the elderly (ranging from 21% in the USA, 36% in Australia, between 40 and 45% in Sweden, Germany, Britain, Spain, the Netherlands & Denmark, to 64% in Switzerland). Cyclists, too, represent a substantial proportion of road deaths, ranging from between 4 percent and 8 percent in Switzerland, OLDER VULNERABLE ROAD USERS xiii

14 Norway, Italy, Austria, Britain and France, between 10 percent and 14 percent in Denmark, Belgium, Germany and Sweden, to 23 percent in the Netherlands, Again, older cyclists are over-represented in these figures, accounting for between 15 percent and over 70 percent of all cyclist fatalities. The nature of injuries to pedestrians and cyclists are severe once involved in a crash, particularly involving a collision with a vehicle because, unlike a vehicle occupant, they are largely unprotected. Even in moderate crashes, the elderly are in greater danger of being seriously injured or killed than younger adults. Injuries sustained in a collision with a vehicle include lower limb fractures and knee damage as a result of contact with the bumper, fractures of the pelvis and femur as a result of contact with the leading edge of the bonnet, and head, shoulder and chest injuries as a result of contact with the rear of the bonnet, the windscreen, roof and ground. More importantly, the elderly are at even greater risk of severe injury because of their greater susceptibility to injury (frailty) compared to younger people. They are more likely to sustain fractures to all body parts in a crash, recovery time is much longer and the likelihood of long-term disability is high. Older pedestrians and cyclists are also over-represented in non-vehicle collisions and are more likely than younger adults to sustain a severe injury as a consequence of falling, tripping or stumbling. Injuries sustained in these types of crashes include upper limb injuries, and head, face and neck injuries. Even though it is difficult to determine the causal factors in many crashes because they are invariably complex in nature and often involve several contributing factors, it is necessary to understand how and to what extent these factors contribute to crash and injury risk. The identified factors fall under three broad categories: road user characteristics, vehicle factors and infrastructure/road design. Much of the literature on older road users is concerned with the consequences of ageing on sensory, perceptual, cognitive and physical abilities and resulting problems coping with traffic. While there is little doubt that the onset of age-related changes affects many areas of daily living, few clear associations between crash risk and specific age-related declines and/or medical conditions have been established, particularly for pedestrian and cyclist crash risk. Indeed, it is argued that many older adults are able to adjust their behaviour in traffic adequately to accommodate for these changes that may affect safe traffic participation and, in general, the majority of older road users do use the road-transport system without injurious consequences. Functional impairments can be partly compensated for by, for example, travelling less frequently, avoiding complex situations, travelling slower or by taking more time to observe traffic. However, there may be some older road users who do not or cannot compensate adequately. Indeed, many researchers now contend that the older road user problem is mainly restricted to certain sub-groups of people who may have poor risk perception or little insight into their changing abilities, or when behavioural and functional declines overwhelm the normal attempts at compensation, rather than encompassing all older people. There is now a shift from a general approach in older road user safety of why older road users have high crash risk? to a differential focus on high-risk subgroups, asking which older road users have high crash risk? Older adults face reducing capabilities with increasing age. This applies to the visual system, it applies to the perceptual and cognitive systems, and it applies to the motoric system. Safe walking and cycling requires the adequate functioning of all these systems and loss of efficiency in any one can reduce performance and increase risk on the road. In addition, the onset of medical conditions that affect vision, physical activity and mental xiv MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE

15 functioning further act to reduce performance. Many older adults will, therefore, experience difficulty perceiving, processing information and acting on that information in order to participate safely in complex traffic. In particular, the problem of selecting a safe gap in which to cross in front of oncoming traffic seems to be a major problem and one that requires intact cognitive-motor skills. Older pedestrians and cyclists experience great problems interacting in fast-moving, complex traffic: walking, initiating walking and adjusting walking pace in the event of an emergency is difficult for many older pedestrians and maintaining balance, and adjusting cycling pace on a bicycle is difficult for many older cyclists. In addition, there are a number of vehicle design features that increase the severity of injuries sustained by pedestrians and cyclists once involved in a crash. The frontal structures of the vehicles (the parts most likely to impact a pedestrian or cyclist) can greatly affect injury outcome. Even though the design of frontal shapes of passenger vehicles has improved over the last decades, there is still much that can be done to reduce the severity of injuries. Current bumper, bonnet and windscreen design is not conducive to pedestrian and cyclist safety. Moreover, the trend of increasing numbers of large and aggressive sports-utility vehicles, four-wheel-drives and vans (often fitted with rigid bullbars) in the vehicle fleet is adversely affecting the injurious consequences to pedestrians and cyclists. Last, the road infrastructure, design and operation affect crash risk of older road users. The growing complexity of the road environment places increasing demands on an older person s adaptability, whilst ageing can diminish the capacity to cope with such situations, placing older road users at a double disadvantage. The current road system is generally designed for vehicles, and mainly for young, fit and healthy road users and, for the most part, seems to be unforgiving for older vulnerable road users. Few facilities are designed specifically for the special needs and capabilities of older vulnerable road users. Older pedestrians and cyclists experience problems in high-speed environments. While the injury consequences of impact speed are ot well understood by pedestrians, cyclists or drivers, they are powerful and well established. Also older adults experience difficulty making appropriate decisions and acting on those decisions in busy, fast-moving traffic because of motion perception and cognitive difficulties. Older pedestrians also experience problems at crossing facilities that are not placed in appropriate locations for convenient and efficient use, do not allow for slower walking speeds, and are not well-designed for people with visual and physical impairments. These facilities, even though they are considered a safety initiative, create stress and confusion for many older pedestrians and are commonly the locations of high crash frequency. Older pedestrians and cyclist also appear to experience problems in complex road and traffic situations such as at intersections, on multi-lane roads with bi-directional and fastmoving traffic. Intersections are major points of conflict between road user groups and the potential for collision is high, particularly collisions between turning vehicles and pedestrians or cyclists continuing in a straight line. The Solutions Meeting the mobility and safety needs of older people in the future will require a comprehensive strategy, one which will encompass policy at all levels and include OLDER VULNERABLE ROAD USERS xv

16 educational and awareness initiatives, improving vehicle design, and ensuring a safe and comfortable road environment in which to walk and cycle. Behavioural change programs and enforcement Educational, awareness and behavioural change programs are aimed at providing information to road users regarding safe practices to adopt to participate in traffic safely. While their effects on crash risk are rarely evaluated, they are regarded as an essential component of any strategy and are, reportedly, well-received by many older community members. There are two main recommendations supporting the use of educative tools to promote safe practices: Continued development and support for community awareness and educational campaigns to increase adoption of safe walking and cycling practices; Continued development and support for programs that promote the continuation of safe driving for as long as possible are recommended, along with development and support of alternative transport options. Moreover, introduction of legislation to enforce adoption of safe practices, supported by mass media campaigns have been successful in bringing about behavioural change. Despite the (largely unsubstantiated) claims that mandatory helmet use is associated with loss of civil liberties and can have an adverse effect on bicycle usage, there is clear and consistent evidence that wearing of head protection reduces the incidence and severity of head and neck injuries. It is recommended that: Careful consideration should be given to legislation for mandatory helmet, coupled with mass media to promote helmet use among all aged cyclists. Vehicle design improvements Improvements to vehicle design can reduce the severity of injuries to pedestrians and cyclists in the event of a collision. Recommendations include: Continued development of test procedures to assess protection capabilities of vehicles for pedestrians and cyclists, and development of test specifications for all new vehicles; Improved design of bumpers to reduce lower limb injuries; Improved design of bonnet leading edge to reduce upper leg and pelvis injuries; Improved bonnet and windscreen design to reduce upper body and head injuries; Discourage the use of large, aggressive vehicles in the vehicle fleet; Consideration of banning rigid bull-bars from on-road vehicles; Development of less aggressive bull-bars; Development of in-vehicle ITS technologies to assist drivers detect and avoid collisions with pedestrians and cyclists; xvi MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE

17 Continued and expanded requirement of use of daytime running lights. Infrastructure, road design and operation improvements Improved infrastructure can achieve cost-effective immediate reductions in crash and injury risk to older pedestrians and cyclists. There needs to be more emphasis and support for a system that is more forgiving of the difficulties experiences by older vulnerable road users. Facilities that address the particular problems and needs of older pedestrians and cyclists should therefore be part of the road-transport system. Recommendations aim to moderate vehicle speeds, separate or reduce pedestrian/cyclist-vehicle interactions, and simplify road and traffic conditions that cause problems for older adults. It is recommended that: Measures to moderate vehicle speeds in high pedestrian and cyclist activity areas should be considered, including: o o o o setting of speed limits of 30 km/h but not more than 50 km/h, extensive use of traffic-calming techniques, use of perceptual countermeasure treatments, and use of in-vehicle and out-of-vehicle ITS technologies; Introduction of measures to separate or restrict vehicular and non-vehicular traffic in high pedestrian and cyclist activity areas, including: o o o o o Provision of vehicle-free or vehicle-restricted pedestrian/cyclist zones; Provision of a well-designed bicycle network of tracks, paths and lanes; Provision of a well-designed footpath network; Provision of barriers or guardrails at unsafe mid-block locations; Provision of crossing facilities suited to older pedestrians needs, including:? Well-placed locations;? Consideration of signalised facilities over unsignalised facilities;? Extending walking speed value to between 0.91 m/s to 1.0 m/s;? Consideration of Puffin/Pussycats devices;? Consideration of measures to reduce confusion about clearance phases;? Consideration of facilities for visually impaired pedestrians,? Inclusion of marked cross-walks in high-risk locations to reduce vehicle approach speeds. Introduction of measures to reduce the complexity of intersections and road lengths: OLDER VULNERABLE ROAD USERS xvii

18 o o o o o o o o Improved intersection design to include treatments that increase conspicuity of pedestrians and cyclists, allow for slower walking and cycling, and establish right-of-way, including: Provision of leading green phases for pedestrians; Consideration of Puffin/Pussycats and TRCS devices; Extension and widening of footpath in conjunction with painting of crosswalks and bicycle lanes; Consideration of setting back holding lines for vehicles and advancing holding lines for bicycles; Provision of warning signs to drivers to give-way to pedestrians and cyclists, especially while negotiating turns at intersections; Installation of pedestrian- and cyclist-friendly roundabouts. Installation of medians to separate bi-directional traffic. Other recommendations include: o o Provision of facilities at public transport stops including passenger safe zones and provision of a free-area on cycle paths; Provision of good street lighting in areas of high pedestrian and cyclists activity. Conclusions Unless there is a fundamental reconsideration of the traffic and transport system to ensure that the mobility and safety needs of older vulnerable road users are met, the problems and risks associated with their transport needs will worsen in the coming decades. While many governmental policies and strategies acknowledge the need to provide safe facilities for special road user groups, little effort in practice has been made to find innovative and effective solutions. By adopting a system-wide and comprehensive application to key crash problems in areas where there is a high concentration of older pedestrians and cyclists, the safe mobility of these road users can be realised. xviii MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE

19 OLDER VULNERABLE ROAD USERS MEASURES TO REDUCE CRASH AND INJURY RISK 1 INTRODUCTION Crashes involving vulnerable road users represents a major road safety problem worldwide and there is growing awareness within the road safety community that vulnerable road users may have their own particular needs and difficulties in using the road transport system and that this should be considered when designing and operating the system. Pedestrians and cyclists are considered extremely vulnerable road users because they are largely unprotected in traffic, compared to vehicle occupants. In a collision with a vehicle, pedestrians and cyclists are always the weakest party and at more risk of injury or death. Furthermore, because of their physical frailty, the elderly are especially vulnerable to injuries and older pedestrians and cyclists are considered two of the most vulnerable road user groups. While car use is a dominant mode of transport for many older people, other forms of transport such as walking and cycling are still important transport modes, particularly for shorter trips. In addition, the socially disadvantaged often depend on walking and cycling for their essential mobility. However, in most Western countries, older pedestrians and cyclists are at a significantly higher risk of death following a crash than younger pedestrians and cyclists. Moreover, research clearly indicates that the types of crashes and injuries sustained by older pedestrians and cyclists differ from crashes in which younger pedestrians and cyclists are involved. The Swedish National Road Administration (SNRA) commissioned the Monash University Accident Research Centre (MUARC) to conduct a literature review to assess the current state of knowledge in regard to the key issues affecting older unprotected road users and to identify a set of best-practice recommendations for managing the safety of this road user group. Specifically, the required review was outlined as follows: Elderly as unprotected road users is a growing problem area which will continue to grow as the percentage of senior citizens in society increases. Due to the bone brittleness that often comes with age, traffic accidents are generally more serious for older persons, often resulting in longer periods of hospitalisation. What type of traffic accident is most common and what are the resulting injuries? Measures to reduce the risk of injury and their impact. In the proposal, MUARC stipulated that the review would assess the current state of knowledge in regard to the following issues: The increased vulnerability associated with ageing, Older pedestrians and cyclist crash types, Ageing, behaviour and pedestrian/cyclist crash risk, Older pedestrian and cyclist injury types, and OLDER VULNERABLE ROAD USERS 1

20 Measures to reduce the crash and injury risk to older pedestrians and cyclists (including infrastructure, road design, vehicle design, road user behaviour and enforcement). This review aims to identify current and emerging issues for older pedestrians and cyclists, and to identify policy and research recommendations to improve the safety of these road user groups while meeting their transport needs and mobility. 1.1 METHOD The review was undertaken by MUARC in collaboration with the Department of Psychology, University of Groningen (the Netherlands). This approach was considered essential due to the fact that cycling is not a major form of transport in Australia, but is a significant form of local travel in a number of European countries, particularly in the Netherlands, Sweden and Denmark. The team at the University of Groningen, therefore, provided input on relevant sections of the review on cyclists. In addition, other prominent research institutions in Europe were invited to act as advisors to the project and to provide European data, namely AVV, SWOV (The Netherlands) and TRL (United Kingdom). The literature search was undertaken on the Australian Transport Index, which contains over 135,000 records of publications from throughout the world, on roads, transport and related fields. Records cover books, reports, journals articles and conference papers. The database is produced by the ARRB Transport Research Library and is Australia s major transport database. As well as the holdings of the ARRB Transport Research Library collection, it also includes the holdings of a number of other Australia libraries with transport-related collections. The TRIS database, produced by the US National Transport Library, the ITRD database, produced by the Organisation for Economic Co-operation and Development (OECD), and PsychInfo/Lit database were also searched for relevant references. In addition, the SWOV library database was searched for relevant European publications. All abstracts were read and selected for relevance and research strength. As a general rule, only publications from 1990 onwards were selected from the literature lists. This criterion was waived, however, where articles appeared to have exceptional worth. 1.2 STRUCTURE OF THE REVIEW This review addresses the many issues associated with the safety of older pedestrians and cyclists. Similarities exist between the problems experienced by older pedestrians and cyclists. For this reason, the review focusses on overlapping issues, identifying the overall problems confronting both pedestrians and cyclists and, where appropriate, discussing issues of particular concern for each group. Chapter 2 provides an overview of the problem. A discussion of the benefits of walking and cycling is provided, along with the mobility needs of older people and provision of safety while meeting mobility requirements. Crash and injury risk data are also provided in this Chapter. Data on pedestrian and cyclist crash risk, crash type and injury type were gathered from Australasia, the USA, and a number of European countries including Sweden, The Netherlands, Britain and Denmark. 2 MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE

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